• J Arthroplasty · Mar 2017

    Clinical Trial

    Serum and Wound Vancomycin Levels After Intrawound Administration in Primary Total Joint Arthroplasty.

    • Jeremiah D Johnson, Joseph M Nessler, Ryan D Horazdovsky, Sandy Vang, Avis J Thomas, and Scott B Marston.
    • Department of Orthopaedic Surgery, Regions Hospital, St. Paul, Minnesota; Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota.
    • J Arthroplasty. 2017 Mar 1; 32 (3): 924-928.

    BackgroundPeriprosthetic joint infection is the most common cause of readmissions after total joint arthroplasty (TJA). Intrawound vancomycin powder (VP) has reduced infection rates in spine surgery; however, there are no data regarding VP in primary TJA.MethodsThirty-four TJA patients received 2 g of VP intraoperatively to investigate VP's pharmacokinetics. Serum and wound concentrations were measured at multiple intervals over 24 hours after closure.ResultsAll serum concentrations were subtherapeutic (<15μg/mL) and peaked 12 hours after closure (4.7μg/mL; standard deviation [SD], 3.2). Wound concentrations were 922 μg/mL (SD, 523) 3 hours after closure and 207 μg/mL (SD, 317) at 24 hours. VP had a half-life of 7.2 hours (95% confidence interval, 7.0-9.3) in TJA wounds.ConclusionsVP produced highly therapeutic intrawound concentrations while yielding low systemic levels in TJA. VP may serve as a safe adjunct in the prevention of periprosthetic joint infection.Copyright © 2015 Elsevier Inc. All rights reserved.

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